title: Acute respiratory failure in kidney transplant recipients: a multicenter study.
abstract: BACKGROUND
  Data on pulmonary complications in renal transplant recipients are scarce. The aim of this study was to evaluate acute respiratory failure (ARF) in renal transplant recipients.
  
  
  METHODS
  We conducted a retrospective observational study in nine transplant centers of consecutive kidney transplant recipients admitted to the intensive care unit (ICU) for ARF from 2000 to 2008.
  
  
  RESULTS
  Of 6,819 kidney transplant recipients, 452 (6.6%) required ICU admission, including 200 admitted for ARF. Fifteen (7.5%) of these patients had combined kidney-pancreas transplantations. The most common causes of ARF were bacterial pneumonia (35.5%), cardiogenic pulmonary edema (24.5%) and extrapulmonary acute respiratory distress syndrome (ARDS) (15.5%). Pneumocystis pneumonia occurred in 11.5% of patients. Mechanical ventilation was used in 93 patients (46.5%), vasopressors were used in 82 patients (41%) and dialysis was administered in 104 patients (52%). Both the in-hospital and 90-day mortality rates were 22.5%. Among the 155 day 90 survivors, 115 patients (74.2%) were dialysis-free, including 75 patients (65.2%) who recovered prior renal function. Factors independently associated with in-hospital mortality were shock at admission (odds ratio (OR) 8.70, 95% confidence interval (95% CI) 3.25 to 23.29), opportunistic fungal infection (OR 7.08, 95% CI 2.32 to 21.60) and bacterial infection (OR 2.53, 95% CI 1.07 to 5.96). Five factors were independently associated with day 90 dialysis-free survival: renal Sequential Organ Failure Assessment (SOFA) score on day 1 (OR 0.68/SOFA point, 95% CI 0.52 to 0.88), bacterial infection (OR 0.43, 95% CI 0.21 to 0.90), three or four quadrants involved on chest X-ray (OR 0.44, 95% CI 0.21 to 0.91), time from hospital to ICU admission (OR 0.98/day, 95% CI 0.95 to 0.99) and oxygen flow at admission (OR 0.93/liter, 95% CI 0.86 to 0.99).
  
  
  CONCLUSIONS
  In kidney transplant recipients, ARF is associated with high mortality and graft loss rates. Increased Pneumocystis and bacterial prophylaxis might improve these outcomes. Early ICU admission might prevent graft loss.
authors.affiliation: Medical Intensive Care Unit and Biostatistics Departments, Saint-Louis Teaching Hospital, 1 avenue Claude Vellefaux, Paris F-75010, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.forename: David
authors.initials: D
authors.lastname: Osman
authors.forename: Jérome
authors.initials: J
authors.lastname: Lambert
authors.forename: Christophe
authors.initials: C
authors.lastname: Guitton
authors.forename: Anne-Elisabeth
authors.initials: AE
authors.lastname: Heng
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.forename: Kada
authors.initials: K
authors.lastname: Klouche
authors.forename: Georges
authors.initials: G
authors.lastname: Mourad
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Eric
authors.initials: E
authors.lastname: Rondeau
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Hourmant
authors.forename: Antoine
authors.initials: A
authors.lastname: Durrbach
authors.forename: Denis
authors.initials: D
authors.lastname: Glotz
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome